GUINEA WORM ERADICATION: IMPACT AND LEGACY Global Health Lecture Series Colorado School of Public Health October 19, 2011
Donald R. Hopkins, MD, MPH – Vice President for Health Programs – The Carter Center
Key Facts About Guinea Worm Disease • Only transmitted by contaminated drinking water • Crippling: health, agriculture, education • Seasonal • One year incubation period • No vaccine or cure • No animal reservoir • Prevention : health education, filters, ABATE®, wells
Impact on School Attendance
Guinea Worm: Interventions
Pipe Filters
Safe Water Sources
Cloth Filters
Health Education ABATE® E. Staub
Early Phase of Global GWEP • 1980 Campaign conceived at CDC • 1981 Endorsed by IDWSSD, WHO • 1982 Conference in Washington • 1983 India launches program • 1985 First Nigerian National Conference
Evidence Base at Start of Guinea Worm Eradication Program (1980) • Knew diagnosis easy, humans only reservoir. • Knew Soviet Union eliminated Guinea worm disease in 1930s. • Knew big impact of high prevalence and long disability on health, agriculture, school attendance (Belcher et al in Ghana 1975; Kale in Nigeria 1977). • Geographic extent of disease, number of cases remaining both unknown.
Evidence Base (cont’d) • Nigeria village 60% >> 0% prevalence in 2 years (water supply). (Muller, 1971) • India villages 97% reduction in cases 1 year after ABATE used (Sastry et al, 1975). • Nigeria documented impact of health education in villages after 3 years (Akpovi et al 1981). 35% (30-70%) prevalence
99% • Improved agricultural production and school attendance • Estimated economic rate of return: 29% • Indirect improvement in infant nutrition, care, immunization
Benefits of Guinea Worm Eradication Program • Increased provision of clean water • Established community-based health education, mobilization and surveillance by village volunteers • Engendered four month “Guinea Worm Cease-Fire” in Sudan • Changed attitudes
Remaining Challenges • • • •
1 year incubation period Reproductive potential Insecurity Fundraising
Guinea Worm Disease: Reproductive Potential • Eritrea 1968 – 1 imported case 58 documented + 40 suspected cases next year • India 1989 – 1 imported case 91 cases next year • Mali 2006 – 1 imported case 86 cases next year
Insecurity
• • • • • •
1995 Guinea Worm Cease-Fire SUDAN 1994-1995 Ethnic fighting GHANA 1991-2003 Lord’s Resistance Army UGANDA 2002 Civil War begins COTE D’IVOIRE 2009 32 incidents disrupt program SOUTHERN SUDAN 2007-2010 Tuareg/Al-Qaeda MALI
Funding • The Carter Center raised $275 million in donations since 1986, including three Gates Foundation grants totaling $88.6 million awarded in between 2000 and 2010. • Estimated $25 million needed to finish the job by 2012.
Coalition of Organizations and Agencies Supporting the Global Campaign to Eradicate Dracunculiasis, 1986-2010* Major Partners Ministries of Health The Carter Center UNICEF U.S. Centers for Disease Control and Prevention The World Bank World Health Organization Governments Arab Fund for Economic and Social Development Canadian International Development Agency (CIDA) Denmark Finland Japan Japan International Cooperation Agency (JICA) Kuwait Fund for Arab Economic Development Luxembourg The Netherlands Nigeria Norway Oman OPEC Fund for International Development Qatar Saudi Arabia Saudi Fund for Development United Arab Emirates United Kingdom Department for International Development (DFID) United States Agency for International Development (USAID)
United Nations Office for the Coordination of Humanitarian Affairs UNDP World Food Programme Other American Red Cross Atlanta Peachtree Rotary Club Health & Development International Mid-Continent University National Democratic Institute for International Affairs Nigerian Women Association of Georgia Nippon Keidanren Simply Living and Calumet Natural Foods Co-operative U.S. Peace Corps Voice of America
*In addition, many generous individuals have supported the Guinea Worm Eradication Program.
Foundations Khalifa Bin Zayed Al Nahyan Foundation Amgen Foundation Atlanta Women’s Club Hugh J. Andersen Foundation Blackie Foundation Boston Foundation Howard G. Buffett Foundation Carani Charitable Foundation Christian Church Foundation Community Foundation of the National Capital Region Crabby Beach Foundation Diebold Foundation Bill & Melinda Gates Foundation W.B. Haley Foundation, Inc. Harris myCFO Foundation Emery C. Jr. and Nancy F. Herman Fund Conrad N. Hilton Foundation John C. and Karyl Kay Hughes Foundation International Humanitarian Foundation John P. Hussman Foundation The Kendeda Fund A.G. Leventis Foundation Lored Foundation Morningside Foundation Salus Mundi Foundation National Christian Charitable Foundation Osprey Foundation of Maryland P Twenty-One Foundation Mary Lynn Richardson Fund Seyfarth Shaw Charitable Foundation United Nations Foundation Woodbury Foundation
Corporations AGCO Corporation American Cyanamid BASF Corporation BellSouth Corporation Chevron Corporation Computer Associates International Defined Health Delta Air Lines, Inc. Delta Medical Supplies E.A. Juffali & Brothers E.I. du Pont de Nemours Environmental Systems Research Institute, Inc. Evergreen International Aviation, Inc. Franklin Mint Georgia-Pacific Corporation Global Aero Logistics / North American Airlines Google.org ITOCHU Corporation Johnson & Johnson Kimberly-Clark Corporation Legendary Films (formerly Ad-Rem Concepts) Precision Fabrics Group, Inc. Ravenswork Selig Enterprises Society of Plastic Engineers, Inc. Trek Bicycle Corporation Tsunami Films UBS Wealth Management Magazine Vestergaard Frandsen Wyeth (formerly American Home Products) YKK Corporation
“The public interest requires doing today those things that men of intelligent good will would wish, five or ten years hence, had been done.” – Edmund Burke (1729-1797)
